Cosmetic surgery without VAT, new in the «Advances» decree. For which interventions and how does it work?

During the conversion of the Advances Decree there are important innovations: among the amendments presented is the introduction of VAT exemption for cosmetic surgery interventions.
But in which cases does the new regulation apply and how can I benefit from the tax discount? How does it work and, above all, for which interventions is the exemption from Value Added Tax provided? Cosmetic surgery without VAT, for which operations and how does it work? VAT exemption arrives on cosmetic surgery procedures.
For which cosmetic surgery procedures is the VAT exemption valid? Can cosmetic surgery be VAT exempt Cosmetic surgery without VAT, how to prove its therapeutic nature? The VAT exemption for cosmetic surgery interventions arrives.
The VAT exemption for medical services is provided for by Article 10, n.18, of Presidential Decree 633 of 1972 which recognizes the VAT exemption for "health services of diagnosis, treatment and rehabilitation rendered to the person in the exercise of health professions and arts subject to supervision", but without specifically outlining the scope of application.
This formulation has generated confusion over time.
The amendment (approved in the Senate Budget Committee) for VAT exemption on surgical interventions was presented by the same majority.
It is applied exclusively for cosmetic surgery services aimed at diagnosing or treating diseases or health problems or protecting, maintaining or restoring health, including psycho-physical health, but on condition that the therapeutic purposes "are demonstrated by a specific medical certificate".
The VAT exemption for cosmetic surgery operations begins with the entry into force of the "Advances" decree, while for previous services the previous regulations remain in force.
For which cosmetic surgery procedures is the VAT exemption valid? It must be underlined that the broad wording of the law suggests that the VAT exemption for cosmetic surgery interventions can be applied broadly.
It certainly finds application in the case of breast augmentation performed following operations to remove breast cancer or in the case of blepharoplasty aimed at restoring the correct field of vision.
Without a doubt, VAT exemption can be obtained for nose surgery and rhinoplasty operations, as they are likely to bring about an improvement in respiratory functions.
read also How much does it cost to get a nose job and when you can get rhinoplasty for free But not only that.
In fact, it could also find application in situations of psychological distress resulting from the non-acceptance of purely aesthetic physical defects or in the case of procedures aimed at changing sexual characteristics.
This reading derives from the fact that the introduced rule speaks of "psycho-physical" health, therefore the medical certificate issued to the individual patient becomes important to delimit the field of application.
Cosmetic surgery can be VAT exempt.
This is not a real novelty as the Court of Cassation had already expressed its opinion on this type of service with order 26906 of 13 September 2022.
Naturally, as there is no specific rule, patients and professionals had to activate a series of procedures from time to time to obtain recognition of the VAT exemption.
The amendment presented to the «Advances» decree allows, however, to clarify doubts and to have a general regulation that is easy to apply.
There is no shortage of first reactions to this important innovation: the president of the Italian Society of Aesthetic Medicine (Sime), Emanuele Bartoletti, underlined in a statement released to Adnkronos that this is a positive rule, but he hopes for an extension of the VAT exemption also for aesthetic medicine procedures.
This extension would be justified by the fact that serious health problems often emerge during aesthetic medicine visits/sessions that patients often ignore.
read also Cosmetic surgery: for which procedures VAT is not paid Cosmetic surgery without VAT, how to prove the therapeutic nature? Certainly the central point of the VAT exemption for cosmetic surgery interventions is the medical certification required by the «Advances» decree.
The same is already central to the VAT exemption regime for surgery and this is reiterated by sentence no.
889 of 27 October 2023 of the Second Instance Tax Court of Justice of the Marche.
The ruling reiterates that, in the event that the professional carries out cosmetic surgery without VAT for therapeutic purposes, he must request the patient's consent to the use of medical documentation for tax purposes.
In the absence of consent, the invoice must be issued which is not VAT exempt.
From this sentence it is clear first of all that already today, therefore before the entry into force of the innovation introduced by the «Advances» decree, it is possible to obtain cosmetic surgery services without VAT, as already mentioned previously.
In the case in question, the professional issues VAT-exempt invoices for medical services, subjected to tax verification/assessment and reiterates that the interventions were carried out under the exemption regime as they correspond to therapeutic purposes.
The First Aid Commission rejects the taxpayer's appeal, who lodges an appeal.
In the second instance, the Commission asks the professional to file accurate documentation relating to the VAT-free cosmetic surgery operations carried out.
In fact, the professional provides by attaching psychiatric and psychological reports (the exemption is also recognized for psychological distress), photos, but these are documents in which the names of the patients are obscured, as required by the privacy law.
The Court reiterates that abstractly the professional's reasons are valid but, having obscured the names in the certifications and photos, it is not possible to link the VAT-exempt invoices issued to the documentation.
The Court therefore reiterates that, in order to obtain VAT exemption for cosmetic surgery interventions, it is necessary to prove the connection between the service and the patient who uses it by requesting, before issuing the invoice, consent to the use of personal data for tax purposes.
Without consent the professional cannot apply the VAT exemption regime.
We must believe that this regulation will also apply following the entry into force of the "Advances" decree for the simple fact that the rule is not entirely innovative as it still requires medical certification regarding the therapeutic nature and no changes in terms of tests.